When service users and personal care workers fall out

Direct payments have allowed more service users to take control of the services they use by directly hiring their own personal assistants. The implications for users and PAs are enormous: both professionally and personally they will be working together very closely. But having a dichotomous relationship in such a confined environment can create problems that, as an employer and employee, aren’t easily solved.

Anna C Young is a service user in Camden who ran into problems when her PA started demanding higher pay. “Previously, I think, we got on very well she stayed for five years as my PA. But things went sour when I got on the Independent Living Fund and she felt I should give her more money,” she says.

The PA no longer works for Young after their relationship deteriorated further.

Young’s case is set to be heard by an employment tribunal. She claims she never arranged a formal contract with the PA. It’s an all-too common problem as relationships between a client and care worker evolve into one of employer and their employee.

Some are suggesting that PAs are going to have to approach their work with a higher degree of professionalism if conflict is to be avoided. Community Care columnist and disability consultant Simon Stevens argues that they should remove the emotional dimension from their work.

He says: “You just have to be quite assertive early on. So literally on day one as a service user, you have to teach good habits.”

Clear boundaries

While it is important for the service user to set clear boundaries in their working relationship with a PA, Helga Pile, Unison’s national officer for social care, argues that the nature of care work means you can’t take emotion out of the equation: “The professional distance is quite difficult. Obviously it varies tremendously depending on the individual. If you’re delivering personal care, it’s difficult to do that within someone’s home. I think it’s less about professional distance and more about suppressing your own opinions sometimes.”

A central issue is whether a service user’s ability to employ a PA means reducing social care to a business transaction between two individuals in order to avoid arguments. It has been frequently argued that personalisation shifts the balance of power from the state to the service user, as direct payments lets them choose the services they want rather than a local authority. But it is not the state that a service user has power over – it’s their new employee.

Unison says there is not enough protection for PAs who are being directly employed. The union is calling for a code of practice for employing assistants and a framework for pay and conditions.

Pile says that the issue is not that disabled people make bad employers, but that these relationships are so new that neither side foresee the sort of problems that regularly cause conflict. “It’s not so much wages that is the problem, as that is dealt with upfront. It tends to be things that emerge down the line – expenses, holiday pay, working hours. The PAs are reluctant to raise these issues because working so closely with someone they don’t really want to get into conflict. But it can emerge that things weren’t as clear as they should have been.”

In particular, says Pile, the cost of training can cause problems. A service user may not be getting enough money to pay for a PA to receive training. And with thousands of PAs joining the workforce over the next few years in need of training, this issue will become more pertinent.

Contract

Dealing with these details in a contract may seem obvious but for most service users having a PA is their first experience of being an employer – and few authorities provide information or training on how to cope with the responsibilities that brings.

Many potential problems can be avoided by ensuring that job details are agreed by both sides, even if employing a family member or a friend. Sorting out the specifics at the start of a relationship also means that training can be discussed with local authorities. Regularly reviewing the contract together can ensure that any new problems that arise can be dealt with before it becomes a full-blown conflict.

Should that happen, then both parties could go to the local authority together to try to resolve the problem. Beyond that, support services for direct payment users are also on hand to give advice if things turn sour. The better ones can provide peer support and ongoing help. But however important they are, says Sue Bott of the National Centre for Independent Living, their provision is currently patchy.

“I think that sometimes when councils put support services out to tender, the full implications of what they’re doing are not realised. It’s not just a matter of providing a service with referrals from social services when a direct payment is set up and that’s the end of it. There’s a lot more involved, such as ongoing support and peer support.”

Bott says that Centres for Independent Living can also provide advice and signpost users to the services. For PAs, the third-party options to find advice are limited. Unions are an obvious place to turn, but only if an assistant is a member. They could alternatively try Citizen Advice Bureaus or Law Centres. But PAs are clearly not as supported as home care workers.

Whose responsibility?

So who should step in if an argument escalates to the point that the PA won’t work with a service user any more? Jon Glasby of the University of Birmingham’s Health Services Management Centre says that while support services can help, it is not ultimately their responsibility to ensure a service user’s needs are being met.

“The local authority retains responsibility to ensure that someone’s needs are met. If there’s a problem between a PA and user to the point that it’s not possible to resolve [it] and the stage is reached that their needs are no longer being met, then there’s a key role for the social worker as to how to meet that person’s needs,” says Glasby.

Worryingly, Young says that the structures to support her after her PA stopped working for her were inadequate. “I don’t think there’s a good infrastructure if things get quite severe. I’m thinking about having a back-up system I can call on. What’s happening now is I’m so nervous about employing someone that the only person who helps is the person who cleans for me.”

But despite the potential problems, Young and Stevens are both keen to continue to directly employ their own assistants.

Says Stevens: “When you get the right person it can last for 10 years and be perfect. But it’s like a lucky dip – you don’t know what you’re going to get.”